title: Clinical outcomes of single versus staged hybrid repair for thoracoabdominal aortic aneurysm.
abstract: OBJECTIVE
  We investigated the outcomes of hybrid repair of thoracoabdominal aortic aneurysms and performed meta-analyses and meta-regressions to assess whether the number of stages during hybrid repair is associated with mortality.
  
  
  METHODS
  Review methods were according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The primary outcome was 30-day mortality. Secondary outcomes of procedural and clinical success were reported descriptively. Meta-analyses, meta-regressions, and logistic regressions were performed to estimate the odds ratio (OR) describing the association between the staging of the operation and in-hospital death.
  
  
  RESULTS
  We included 19 studies of 660 patients. Procedures were single-staged in 288 patients and staged in 372. Perioperative mortality ranged from 0% to 44.4%, and spinal cord ischemia ranged from 0% to 15.3%. After a mean follow-up of 26 months (range, 6-88.5 months), the overall mortality was 20.8%. The meta-regression of all studies' summary data (OR, 0.64; 95% confidence interval [CI], 0.19-2.16; P = .45; I(2) = 0.42) and a meta-regression where mortality rates in four studies were stratified by operative staging (OR, 0.57; 95% CI, 0.24-1.36; P = .19; I(2) = 0.38) supported a two-stage procedure but failed to reach statistical significance. Logistic regressions of individual patient data from a single center demonstrated evidence that a staged procedure was safer (adjusted OR, 0.04; 95% CI, 0.00-0.96; P < .05).
  
  
  CONCLUSIONS
  Hybrid repair of thoracoabdominal aortic aneurysms may reduce early morbidity and mortality even in a group considered high risk for open surgery but still carries risks of perioperative complications. This study suggested advantages to a staged procedure, but statistically significant evidence is lacking. Prospective data are still needed to optimize hybrid repair and best define its role.
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom. Electronic address: ludoviccanaud@hotmail.com.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Canaud
authors.forename: Alan
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: Dan
authors.initials: D
authors.lastname: Jackson
authors.forename: Lynne
authors.initials: L
authors.lastname: Cresswell
authors.forename: Michael
authors.initials: M
authors.lastname: Cliff
authors.forename: S Sheraz
authors.initials: SS
authors.lastname: Markar
authors.forename: Gary
authors.initials: G
authors.lastname: Maytham
authors.forename: Steven
authors.initials: S
authors.lastname: Black
authors.forename: Matt
authors.initials: M
authors.lastname: Thompson
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome